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Lieber J, Banjara SK, Mallinson PAC, Mahajan H, Bhogadi S, Addanki S, Birk N, Song W, Shah AS, Kurmi O, Iyer G, Kamalakannan S, Kishore Galla R, Sadanand S, Dasi T, Kulkarni B, Kinra S. Burden, determinants, consequences and care of multimorbidity in rural and urbanising Telangana, India: protocol for a mixed-methods study within the APCAPS cohort. BMJ Open 2023; 13:e073897. [PMID: 38011977 PMCID: PMC10685937 DOI: 10.1136/bmjopen-2023-073897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 11/10/2023] [Indexed: 11/29/2023] Open
Abstract
INTRODUCTION The epidemiological and demographic transitions are leading to a rising burden of multimorbidity (co-occurrence of two or more chronic conditions) worldwide. Evidence on the burden, determinants, consequences and care of multimorbidity in rural and urbanising India is limited, partly due to a lack of longitudinal and objectively measured data on chronic health conditions. We will conduct a mixed-methods study nested in the prospective Andhra Pradesh Children and Parents' Study (APCAPS) cohort to develop a data resource for understanding the epidemiology of multimorbidity in rural and urbanising India and developing interventions to improve the prevention and care of multimorbidity. METHODS AND ANALYSIS We aim to recruit 2100 APCAPS cohort members aged 45+ who have clinical and lifestyle data collected during a previous cohort follow-up (2010-2012). We will screen for locally prevalent non-communicable, infectious and mental health conditions, alongside cognitive impairments, disabilities and frailty, using a combination of self-reported clinical diagnosis, symptom-based questionnaires, physical examinations and biochemical assays. We will conduct in-depth interviews with people with varying multimorbidity clusters, their informal carers and local healthcare providers. Deidentified data will be made available to external researchers. ETHICS AND DISSEMINATION The study has received approval from the ethics committees of the National Institute of Nutrition and Indian Institute of Public Health Hyderabad, India and the London School of Hygiene and Tropical Medicine, UK. Meta-data and data collection instruments will be published on the APCAPS website alongside details of existing APCAPS data and the data access process (www.lshtm.ac.uk/research/centres-projects-groups/apcaps).
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Affiliation(s)
- Judith Lieber
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
| | | | - Poppy Alice Carson Mallinson
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
| | - Hemant Mahajan
- National Institute of Nutrition, Hyderabad, Telangana, India
| | | | | | - Nick Birk
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
| | - Wenbo Song
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
- Nagasaki University, Nagasaki, Japan
| | - Anoop Sv Shah
- Centre for Global Chronic Conditions, Faculty of Epidemiology and Population Health, Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Om Kurmi
- Coventry University, Coventry, UK
| | - Gowri Iyer
- Indian Institute of Public Health Hyderabad, Hyderabad, India
| | - Sureshkumar Kamalakannan
- SACDIR, Public Health Foundation of India, New Delhi, India
- International Center for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Shilpa Sadanand
- Indian Institute of Public Health Hyderabad, Hyderabad, India
| | - Teena Dasi
- National Institute of Nutrition, Hyderabad, Telangana, India
| | - Bharati Kulkarni
- National Institute of Nutrition, Hyderabad, Telangana, India
- Indian Council of Medical Research, New Delhi, India
| | - Sanjay Kinra
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
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AlShareef SM. Validation of the Arabic Version of the European Community Respiratory Health Survey Screening Questionnaire. J Asthma Allergy 2023; 16:735-742. [PMID: 37492585 PMCID: PMC10364826 DOI: 10.2147/jaa.s421175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 07/12/2023] [Indexed: 07/27/2023] Open
Abstract
Purpose The European Community Respiratory Health Survey (ECRHS) questionnaire has been widely used in epidemiological studies to quantify respiratory symptoms and screen for asthma, but there is no formally validated Arabic version. This study developed an Arabic ECRHS screening questionnaire, comprehensively evaluated its reliability and validity, and used it to estimate the population prevalence of respiratory symptoms and asthma in Saudi Arabia. Methods The ECRHS screening questionnaire was adapted to Arabic through translation and back-translation by bilinguals with consultation to a professional committee and lay panel. Reliability and validity were evaluated in a prospective, cross-sectional convenience sample of adults (>18 years) between January and July 2022 in Riyadh, Saudi Arabia. A subgroup completed the questionnaire again three weeks later to assess test-retest reliability. All respiratory symptom-positive participants were invited for spirometry to diagnose asthma according to GINA criteria. Internal consistency was assessed using Cronbach's α coefficient, test-retest reliability with Cohen κ coefficients, and reliability by calculating the sensitivity and specificity for diagnosing asthma. Results Of 2500 invited individuals, 1881 participated (75.2%). A total of 668 (35.5%) participants reported respiratory symptoms according to the ECRHS questionnaire, and 157/1881 (8.3%) had a current diagnosis of asthma on ECRHS questions. Cronbach's α coefficient for internal consistency was 0.831, "good" internal consistency. The test-retest reliability (n = 303) was "excellent" for all questions (Cohen's κ≥0.75). A total of 543 (81.3%) screening-positive participants underwent spirometry, of whom 278 (52%) were diagnosed with asthma according to GINA guidelines, an overall estimated prevalence of 14.8%. Most questions showed good-to-fair specificity and variable sensitivity for physician-diagnosed asthma. Conclusion This Arabic version of the ECRHS screening questionnaire is conceptually similar to the English version, comprehensible, and reliable. Many asthma cases remain hidden and undiagnosed. In addition to utility in epidemiological studies, the ECRHS screening questionnaire might be a simple, quick, and useful tool for asthma case finding.
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Affiliation(s)
- Saad Mohammed AlShareef
- Department of Medicine, College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, 13317-4233, Saudi Arabia
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Samuel R, Carroll MTC, Ikin JF, Gao CX, Del Monaco A, McFarlane A, Berger E, Maybery D, Broder J, Brown D, Sim MR, Walker J, Abramson MJ. Associations between self-reported respiratory symptoms and non-specific psychological distress following exposure to a prolonged landscape fire. Stress Health 2022; 38:364-374. [PMID: 34478608 DOI: 10.1002/smi.3097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 07/05/2021] [Accepted: 08/11/2021] [Indexed: 11/07/2022]
Abstract
We investigated the association between respiratory symptoms and psychological distress in the context of a prolonged smoke event, and evaluated whether smoke exposure, or pre-existing respiratory and mental health conditions, influenced the association. Three thousand ninety-six residents of a rural town heavily exposed to smoke from the 6-week Hazelwood coal mine fire, and 960 residents of a nearby unexposed town, completed Kessler's psychological distress questionnaire (K10) and a modified European Community Respiratory Health Survey. Logistic regression models evaluated associations between distress and respiratory symptoms, with interactions fitted to evaluate effect modification. Smoke exposed participants reported higher levels of distress than those unexposed, and participants reporting respiratory symptoms recorded higher levels of distress than participants without respiratory symptoms, irrespective of exposure. 5-unit increments in K10 scores were associated with 21%-48% increases in the odds of reporting respiratory symptoms. There were significant interactions with pre-existing asthma, chronic obstructive pulmonary disease and mental health conditions, but not with smoke exposure. Although participants with pre-existing conditions were more likely to report respiratory symptoms, increasing distress was most strongly associated with respiratory symptoms among those without pre-existing conditions. Communities exposed to landscape fire smoke could benefit from interventions to reduce both psychological and respiratory distress.
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Affiliation(s)
- Riana Samuel
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Matthew T C Carroll
- Monash Rural Health - Churchill, Monash University, Churchill, Victoria, Australia
| | - Jillian F Ikin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Caroline X Gao
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Centre for Youth Mental Health (Orygen), University of Melbourne, Melbourne, Victoria, Australia
| | - Anthony Del Monaco
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Alexander McFarlane
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Emily Berger
- Monash Rural Health - Churchill, Monash University, Churchill, Victoria, Australia.,Faculty of Education, Monash University, Clayton, Victoria, Australia
| | - Darryl Maybery
- Monash Rural Health - Warragul, Monash University, Warragul, Victoria, Australia
| | - Jonathan Broder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - David Brown
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Malcolm R Sim
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Judi Walker
- Monash Rural Health - Churchill, Monash University, Churchill, Victoria, Australia
| | - Michael J Abramson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Cherry N, Beach J, Galarneau JM. The Health of Firefighters Deployed to the Fort McMurray Fire: Lessons Learnt. Front Public Health 2021; 9:692162. [PMID: 34858913 PMCID: PMC8632044 DOI: 10.3389/fpubh.2021.692162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 10/18/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction: Firefighters were working in exceptionally difficult conditions during the Fort McMurray/Horse River fire in May 2016. Methods: From mid-May, we recruited firefighters from 13 fire services as they returned from the fire. In October 2016 we extended recruitment to all Alberta-based firefighters deployed to the fire. In December 2017-May 2018 we sent a first online follow-up: this concentrated on mental health supports. The second follow-up, in October 2018-January 2019, included screening scales for respiratory ill-health and PTSD. All three contacts included visual analogue scales for chest symptoms and the Hospital Anxiety and Depression Scale. We estimated exposure to PM2.5, and calculated an exposure mitigation index from reports of respiratory protective equipment (RPE). Results: We recruited 1,234 firefighters and examined the relation of respiratory symptoms to estimated particulate exposure. The relation was strong immediately post fire but weakened over time. We found less chest tightness and cough in those whose RPE in the first week mitigated exposure by at least 10%. We examined the relation between particulate exposure and mental ill-health from screening questionnaires and found those with high exposure (reflecting the ferocity of the fire) had poorer mental health scores. Firefighters reporting their "worst moment during the fire" was life threatening were more anxious at second follow-up. Overall both anxiety and depression scores increased at successive contacts, more so in those with mental ill-health recorded in physician billing records before the fire. Discussion: The results from this study overall suggest on-going fire-related health effects in a substantial minority of firefighters, similar to those reported in the longitudinal follow-up of firefighters after the collapse of the World Trade Centre. Self-reports of both respiratory symptoms and mental ill-health were strongly related, soon after the fire, to estimated particulate exposures. Anxiety increased over time since the fire in those who felt their life or safety had been threatened, underlining the need for ongoing support. Our conclusions about the benefits of rapid research relate particularly to the collection of biomarkers of exposure as quickly and widely as possible, and the establishment of a nominal list of participants before they are too widely dispersed.
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Affiliation(s)
- Nicola Cherry
- Division of Preventive Medicine, University of Alberta, Edmonton, AB, Canada
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Respiratory Outcomes of Firefighter Exposures in the Fort McMurray Fire: A Cohort Study From Alberta Canada. J Occup Environ Med 2021; 63:779-786. [PMID: 34491965 DOI: 10.1097/jom.0000000000002286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Determine effects on respiratory health of firefighters attending a catastrophic wildfire. METHODS Within the Alberta Administrative Health Database, we identified five community-based controls for each firefighter in a cohort of 1234 deployed to the 2016 Fort McMurray fire. Spirometry records were identified and a stratified sample assessed clinically. We estimated PM2.5 particles exposure. RESULTS Firefighters had an increased risk of asthma consultation post-fire (OR new onset asthma = 2.56; 95%CI 1.75 to 3.74). Spirometry showed decreased FEV1 and FVC with increasing exposure. In the clinical assessment, 20% had a positive MCT and 21% BWT. Those with ongoing fire-related symptoms had a higher concurrence of positive MCT and BWT (OR = 4.35; 95%CI 1.11 to 17.12). Lower diffusion capacity related to higher exposure. CONCLUSIONS Massive exposures during a wildfire are associated with non-resolving airways damage.
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Cherry N, Beach J, Galarneau JM. Are Inflammatory Markers an Indicator of Exposure or Effect in Firefighters Fighting a Devastating Wildfire? Follow-up of a Cohort in Alberta, Canada. Ann Work Expo Health 2021; 65:635-648. [PMID: 33620067 PMCID: PMC8254513 DOI: 10.1093/annweh/wxaa142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 11/17/2020] [Accepted: 12/23/2020] [Indexed: 11/29/2022] Open
Abstract
Objectives The Fort McMurray fire in Alberta, Canada, devastated the townsite in May 2016. First responders were heavily exposed to smoke particles. Blood samples taken from firefighters in May and August/September 2016 were used to measure concentrations of inflammatory markers in plasma and the relation of these markers to exposures and respiratory ill-health. Methods Blood samples were drawn from firefighters from two fire services, who also completed questionnaires about tasks and exposures during their deployment to the fire and about respiratory symptoms. Plasma was analysed for 42 inflammatory markers in a multiplex assay. At Service A, samples were collected twice, within 19 days of the start of the fire (early sample) and again 14–18 weeks later (late sample). At Service B, only late samples were collected, at 16–20 weeks. Principal component (PC) scores were extracted from markers in plasma from the early and late samples and, at both time periods, the first two components retained. PC scores were examined against estimated cumulative exposures to PM2.5 particles, self-rated physical stressors during the fire, and time since the last deployment to an active fire. The relation of component scores and exposure estimates to respiratory health were examined, using self-ratings at the time of the blood draw, a validated respiratory screening questionnaire (the European Community Respiratory Health Survey [ECRHS]) some 30 months after the fire, and clinical assessments in 2019–2020. Results Repeat blood samples were available for 68 non-smoking first responders from Service A and late samples from 160 non-smokers from both services. In the 68 with two samples, marker concentrations decreased from early to late samples for all but 3 of the 42 markers, significantly so (P < 0.05) for 25. The first component extracted from the early samples (C1E) was unrelated to respiratory symptoms but the second (C2E) was weakly related to increased cough (P = 0.079) and breathlessness (P = 0.068) and a lower forced expiratory volume in one second/forced expiratory capacity (FEV1/FVC)(β = –1.63, 95% CI –3.11 to –0.14) P = 0.032. The first PC at 14–20 weeks (C1L) was unrelated to exposure or respiratory health but the second PC (C2L) from these late samples, drawn from both fire services, related to cumulative PM2.5 exposure. In a multivariate model, clustered within fire service, cumulative exposure (β = 0.19, 95% CI 0.09–0.30), dehydration (β = 0.65, 95% CI 0.04–1.27) and time since last deployed to a fire (β = –0.04, 95% CI –0.06 to –0.01) were all related to the C2L score. This score was also associated with respiratory symptoms of wheezing, chest tightness, and breathlessness at the time of the blood draw but not to symptoms at later follow-up. However, apart from the lower FEV1/FVC at 15–19 days, the marker scores did not add to regression models that also included estimated cumulative PM2.5 exposure. Conclusions Concentrations of persisting inflammatory markers in the plasma of firefighters deployed to a devastating fire decreased with time and were related to estimates of exposure. Although not a powerful independent predictor of later respiratory ill-health, they may serve as an indicator of previous high exposure in the absence of contemporary exposure estimates.
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Affiliation(s)
- Nicola Cherry
- Division of Preventive Medicine, University of Alberta Edmonton, Canada
| | - Jeremy Beach
- Division of Preventive Medicine, University of Alberta Edmonton, Canada
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Asthma increased in young adults from 2008-2016 despite stable allergic rhinitis and reduced smoking. PLoS One 2021; 16:e0253322. [PMID: 34166402 PMCID: PMC8224942 DOI: 10.1371/journal.pone.0253322] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 06/03/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Studies have produced inconsistent results on prevalence trends in asthma and allergic rhinitis (AR). We surveyed young adults about asthma in 2008 and 2016 and examined the impact of gender, AR and smoking. METHODS Thirty-thousand randomly selected subjects aged 16-75 years in Western Sweden received postal questionnaires in 2008 and 50,000 in 2016. This study is based on responders aged 16-25 years, 2,143 in 2008 and 2,484 in 2016. RESULTS From 2008-2016 current asthma increased from 9.3% to 11.5% (p = 0.014) and was significant in males without AR (aOR 1.83, 95% CI 1.09-3.07) and male smokers (aOR 3.02, 95% CI 1.12-8.13). In both years the risk of current asthma was reduced by growing up on a farm (aOR 0.26, 95% CI 0.81-0.84 and aOR 0.47, 95% CI 0.23-0.996), independent of a family history of asthma or allergy. AR did not differ significantly from 2008-2016 (22.5% vs 24.4%, p = 0.144). Current smoking decreased from 20.3% to 15.2% (p<0.001), especially in females (23.5% to 16.2%, p<0.001). Female smokers started smoking later and smoked fewer cigarettes in 2016 than 2008. In 2016, 4.8% of the cohort reported using electronic cigarettes. Of those, 60.7% also smoked tobacco and more than two-thirds who used both (67.2%) were heavy smokers. CONCLUSION Current asthma increased in respondents aged 16-25 from 2008-2016, mainly among males without AR and male smokers. Current AR levelled off in this young population, while current smoking decreased among females.
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Gomez-Rubio P, Zock JP, Rava M, Marquez M, Sharp L, Hidalgo M, Carrato A, Ilzarbe L, Michalski C, Molero X, Farré A, Perea J, Greenhalf W, O'Rorke M, Tardón A, Gress T, Barberà V, Crnogorac-Jurcevic T, Domínguez-Muñoz E, Muñoz-Bellvís L, Alvarez-Urturi C, Balcells J, Barneo L, Costello E, Guillén-Ponce C, Kleeff J, Kong B, Lawlor R, Löhr M, Mora J, Murray L, O'Driscoll D, Peláez P, Poves I, Scarpa A, Real FX, Malats N. Reduced risk of pancreatic cancer associated with asthma and nasal allergies. Gut 2017; 66:314-322. [PMID: 26628509 DOI: 10.1136/gutjnl-2015-310442] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 10/26/2015] [Accepted: 10/28/2015] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Studies indicate an inverse association between ductal adenocarcinoma of the pancreas (PDAC) and nasal allergies. However, controversial findings are reported for the association with asthma. Understanding PDAC risk factors will help us to implement appropriate strategies to prevent, treat and diagnose this cancer. This study assessed and characterised the association between PDAC and asthma and corroborated existing reports regarding the association between allergies and PDAC risk. DESIGN Information about asthma and allergies was collated from 1297 PDAC cases and 1024 controls included in the PanGenEU case-control study. Associations between PDAC and atopic diseases were studied using multilevel logistic regression analysis. Meta-analyses of association studies on these diseases and PDAC risk were performed applying random-effects model. RESULTS Asthma was associated with lower risk of PDAC (OR 0.64, 95% CI 0.47 to 0.88), particularly long-standing asthma (>=17 years, OR 0.39, 95% CI 0.24 to 0.65). Meta-analysis of 10 case-control studies sustained our results (metaOR 0.73, 95% CI 0.59 to 0.89). Nasal allergies and related symptoms were associated with lower risk of PDAC (OR 0.66, 95% CI 0.52 to 0.83 and OR 0.59, 95% CI 0.46 to 0.77, respectively). These results were supported by a meta-analysis of nasal allergy studies (metaOR 0.6, 95% CI 0.5 to 0.72). Skin allergies were not associated with PDAC risk. CONCLUSIONS This study shows a consistent inverse association between PDAC and asthma and nasal allergies, supporting the notion that atopic diseases are associated with reduced cancer risk. These results point to the involvement of immune and/or inflammatory factors that may either foster or restrain pancreas carcinogenesis warranting further research to understand the molecular mechanisms driving this association.
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Affiliation(s)
- Paulina Gomez-Rubio
- Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Center (CNIO), Madrid, Spain
| | - Jan-Paul Zock
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
| | - Marta Rava
- Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Center (CNIO), Madrid, Spain
| | - Mirari Marquez
- Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Center (CNIO), Madrid, Spain
| | - Linda Sharp
- National Cancer Registry Ireland, Cork, Ireland, and Institute of Health & Society, Newcastle University, UK
| | | | - Alfredo Carrato
- Department of Oncology, Hospital Ramón y Cajal, Madrid, Spain
| | - Lucas Ilzarbe
- Hospital del Mar-Parc de Salut Mar, Barcelona, Spain
| | | | - Xavier Molero
- Exocrine Pancreas Research Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Antoni Farré
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - José Perea
- Department of Surgery, 12 de Octubre University Hospital, Madrid, Spain
| | | | - Michael O'Rorke
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Adonina Tardón
- Instituto Universitario de Oncología del Principado de Asturias, Oviedo, Spain
| | - Thomas Gress
- Department of Gastroenterology, University Hospital Giessen and Marburg, Marburg, Germany
| | - Victor Barberà
- Laboratorio de Genética Molecular, Hospital General Universitario de Elche, Elche, Spain
| | | | | | - Luís Muñoz-Bellvís
- Cirugía General y del Aparato Digestivo, Hospital Universitario de Salamanca, Salamanca, Spain
| | | | - Joaquim Balcells
- Exocrine Pancreas Research Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Luis Barneo
- Instituto Universitario de Oncología del Principado de Asturias, Oviedo, Spain
| | | | | | - Jörg Kleeff
- Technical University of Munich, Munich, Germany
| | - Bo Kong
- Technical University of Munich, Munich, Germany
| | - Rita Lawlor
- Department of Pathology and Diagnostics, University of Verona, Verona, Italy
| | - Matthias Löhr
- Gastrocentrum, Karolinska Institutet, Stockholm, Sweden
| | - Josefina Mora
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Lim Murray
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Damian O'Driscoll
- National Cancer Registry Ireland, Cork, Ireland, and Institute of Health & Society, Newcastle University, UK
| | - Pablo Peláez
- Department of Surgery, 12 de Octubre University Hospital, Madrid, Spain
| | - Ignasi Poves
- Hospital del Mar-Parc de Salut Mar, Barcelona, Spain
| | - Aldo Scarpa
- Department of Pathology and Diagnostics, University of Verona, Verona, Italy
| | - Francisco X Real
- Epithelial Carcinogenesis Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Núria Malats
- Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Center (CNIO), Madrid, Spain
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Watanabe M, Kurai J, Sano H, Torai S, Yanase H, Funakoshi T, Fukada A, Hayakawa S, Kitano H, Shimizu E. Prevalence of allergic rhinitis based on the SACRA questionnaire among Japanese nursing professionals with asthma. THE JOURNAL OF MEDICAL INVESTIGATION 2017; 63:108-13. [PMID: 27040063 DOI: 10.2152/jmi.63.108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Although adult asthma is attributable to occupational factors and asthma and rhinitis are related, relatively few studies have investigated the prevalence of occupational rhinitis based on occupation, and knowledge of occupational rhinitis in Japan is currently limited. The objective of this cross-sectional study was to estimate the prevalence of allergic rhinitis among Japanese nursing professionals with asthma. A postal survey was conducted from October to December 2013 using translated versions of the European Community Respiratory Health Survey for the prevalence of asthma and State of the Impact of Allergic Rhinitis on Asthma Control questionnaire for the prevalence of rhinitis. Of 4,634 Japanese nursing professionals, 497 subjects had asthma, and 270 of these 497 subjects had allergic rhinitis (54.3%; 95% confidence interval [CI], 49.7-58.7). Latex allergy was significantly associated with allergic rhinitis (odds ratio, 1.77; 95% CI, 1.21-2.60). There was no relationship between employment period and prevalent allergic rhinitis. The results of this study provide fundamental information regarding occupational health among Japanese nursing professionals, including the prevalence of allergic rhinitis among Japanese nursing professionals with asthma and latex allergy as a potential risk factor for prevalent allergic rhinitis.
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Affiliation(s)
- Masanari Watanabe
- Department of Respiratory Medicine and Rheumatology, Tottori University Faculty of Medicine
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Deliu M, Sperrin M, Belgrave D, Custovic A. Identification of Asthma Subtypes Using Clustering Methodologies. Pulm Ther 2016; 2:19-41. [PMID: 27512723 PMCID: PMC4959136 DOI: 10.1007/s41030-016-0017-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Indexed: 02/07/2023] Open
Abstract
Asthma is a heterogeneous disease comprising a number of subtypes which may be caused by different pathophysiologic mechanisms (sometimes referred to as endotypes) but may share similar observed characteristics (phenotypes). The use of unsupervised clustering in adult and paediatric populations has identified subtypes of asthma based on observable characteristics such as symptoms, lung function, atopy, eosinophilia, obesity, and age of onset. Here we describe different clustering methods and demonstrate their contributions to our understanding of the spectrum of asthma syndrome. Precise identification of asthma subtypes and their pathophysiological mechanisms may lead to stratification of patients, thus enabling more precise therapeutic and prevention approaches.
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Affiliation(s)
- Matea Deliu
- />Centre for Health Informatics, Institute of Population Health, University of Manchester, Manchester, UK
| | - Matthew Sperrin
- />Centre for Health Informatics, Institute of Population Health, University of Manchester, Manchester, UK
| | | | - Adnan Custovic
- />Department of Paediatrics, Imperial College London, London, UK
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Song WJ, Lee SH, Kang MG, Kim JY, Kim MY, Jo EJ, Lee SY, Lee SE, Kim MH, Yang MS, Kim SH, Kang HR, Park HK, Park HW, Chang YS, Kim SS, Lee JM, Min KU, Cho SH. Validation of the Korean version of the European Community Respiratory Health Survey screening questionnaire for use in epidemiologic studies for adult asthma. Asia Pac Allergy 2015; 5:25-31. [PMID: 25653917 PMCID: PMC4313752 DOI: 10.5415/apallergy.2015.5.1.25] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 12/25/2014] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Standardized questionnaire is one of key instruments for general population surveys. OBJECTIVE The present study aimed to develop and validate the Korean version of the European Community Respiratory Health Survey (ECRHS) screening questionnaire for adult asthma surveys. METHODS The ECRHS screening questionnaire was translated into Korean language according to the international criteria. Study participants were prospectively recruited from six referral hospitals and one health check-up center. Comprehensibility of the translation was tested in a pilot study of 10 patients. The reliability was evaluated by internal consistency and test-retest repeatability. Validity was assess with regard to physician-diagnosed asthma. RESULTS A total of 100 adult asthma patients and 134 volunteers were recruited. Reliability was examined for 10 items in 100 asthmatics; Cronbach α coefficients were 0.84, and test-retest repeatability was good (Cohen κ coefficient, 0.71-1.00). Validity was assessed for 8 items in 234 participants; in particular, 'recent wheeze' showed a high sensitivity (0.89) for physician-diagnosed asthma. 'Recent asthma attack' and 'current asthma medication' showed high specificity (0.96-0.98). CONCLUSION The present study demonstrated that the Korean version of the ECRHS screening questionnaire was comprehensible, reliable and valid. We suggest the questionnaire to be utilized in further epidemiological studies for asthma in Korean adult populations.
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Affiliation(s)
- Woo-Jung Song
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 110-799, Korea
| | - So-Hee Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 110-799, Korea
- Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul 135-984, Korea
| | - Min-Gyu Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 110-799, Korea
| | - Ju-Young Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 110-799, Korea
| | - Mi-Young Kim
- Department of Internal Medicine, Inje University Pusan Paik Hospital, Busan 614-735, Korea
| | - Eun-Jung Jo
- Department of Internal Medicine, Pusan National University School of Medicine, Busan 626-870, Korea
| | - Suh-Young Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 110-799, Korea
| | - Seung-Eun Lee
- Department of Internal Medicine, Pusan National University School of Medicine, Busan 626-870, Korea
| | - Min-Hye Kim
- Department of Internal Medicine, Kyungpook National University Medical School, Daegu 700-842, Korea
| | - Min-Suk Yang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 110-799, Korea
| | - Sae-Hoon Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 110-799, Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam 463-707, Korea
| | - Hye-Ryun Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 110-799, Korea
| | - Hye-Kyung Park
- Department of Internal Medicine, Pusan National University School of Medicine, Busan 626-870, Korea
| | - Heung-Woo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 110-799, Korea
| | - Yoon-Seok Chang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 110-799, Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam 463-707, Korea
| | - Sun-Sin Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 110-799, Korea
- Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul 135-984, Korea
| | - Jong-Myung Lee
- Department of Internal Medicine, Kyungpook National University Medical School, Daegu 700-842, Korea
| | - Kyung-Up Min
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 110-799, Korea
| | - Sang-Heon Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 110-799, Korea
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Iqbal S, Oraka E, Chew GL, Flanders WD. Association between birthplace and current asthma: the role of environment and acculturation. Am J Public Health 2013; 104 Suppl 1:S175-82. [PMID: 24354818 DOI: 10.2105/ajph.2013.301509] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We evaluated associations between current asthma and birthplace among major racial/ethnic groups in the United States. METHODS We used multivariate logistic regression methods to analyze data on 102,524 children and adolescents and 255,156 adults in the National Health Interview Survey (2001-2009). RESULTS We found significantly higher prevalence (P < .05) of current asthma among children and adolescents (9.3% vs 5.1%) and adults (7.6% vs 4.7%) born in the 50 states and Washington, DC (US-born), than among those born elsewhere. These differences were among all age groups of non-Hispanic Whites, non-Hispanic Blacks, and Hispanics (excluding Puerto Ricans) and among Chinese adults. Non-US-born adults with 10 or more years of residency in the United States had higher odds of current asthma (odds ratio = 1.55; 95% confidence interval = 1.25, 1.93) than did those who arrived more recently. Findings suggested a similar trend among non-US-born children. CONCLUSIONS Current asthma status was positively associated with being born in the United States and with duration of residency in the United States. Among other contributing factors, changes in environment and acculturation may explain some of the differences in asthma prevalence.
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Affiliation(s)
- Shahed Iqbal
- Shahed Iqbal, Emeka Oraka, and Ginger L. Chew are with the Air Pollution and Respiratory Health Branch, and W. Dana Flanders is with the Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA. W. Dana Flanders is also with the Rollins School of Public Health, Emory University, Atlanta
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13
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Asthma and wheezing are associated with depression and anxiety in adults: an analysis from 54 countries. Pulm Med 2013; 2013:929028. [PMID: 23577252 PMCID: PMC3613067 DOI: 10.1155/2013/929028] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Accepted: 02/03/2013] [Indexed: 11/18/2022] Open
Abstract
Background. Asthma and depression are important public-health concerns worldwide. While some epidemiologic studies have shown asthma and wheezing to be associated with depression and anxiety, the patterns are unclear at the multinational level due to the lack of cross-study comparability. Our study examined the associations of self-reported asthma diagnosis and current wheezing with self-reported depression diagnosis and 30-day anxiety using an international survey. Methods. Using the 2002 World Health Survey, a standardized international survey conducted by the WHO, we estimated the associations between diagnosed asthma and current wheezing with diagnosed depression and 30-day anxiety via multiple logistic regressions for 54 countries worldwide. Results. Diagnosed depression and 30-day anxiety were associated with diagnosed asthma in 65% and 40% of the countries, respectively. Diagnosed depression and 30-day anxiety were associated with current wheezing in 83% and 82% of the countries, respectively. Conclusions. The association between asthma and depression was generally seen at the global level. These results indicated the importance of addressing the asthma-depression comorbidity as public-health and clinical management priorities, in order to improve the overall health of the countries.
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14
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Weinmayr G, Keller F, Kleiner A, du Prel JB, Garcia-Marcos L, Batllés-Garrido J, Garcia-Hernandez G, Suarez-Varela MM, Strachan DP, Nagel G. Asthma phenotypes identified by latent class analysis in the ISAAC phase II Spain study. Clin Exp Allergy 2013; 43:223-32. [DOI: 10.1111/cea.12035] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Revised: 08/15/2012] [Accepted: 08/23/2012] [Indexed: 02/02/2023]
Affiliation(s)
- G. Weinmayr
- Institute of Epidemiology and Medical Biometry; Ulm University; Ulm; Germany
| | - F. Keller
- Department of Child and Adolescent Psychiatry and Psychotherapy; Ulm University; Ulm; Germany
| | - A. Kleiner
- Institute of Epidemiology and Medical Biometry; Ulm University; Ulm; Germany
| | - J. B. du Prel
- Institute of Epidemiology and Medical Biometry; Ulm University; Ulm; Germany
| | - L. Garcia-Marcos
- Pediatric Respiratory and Allergy Units; “Arrixaca” University Children's Hospital; University of Murcia; CIBER of Epidemiology and Public Health (CIBERSP); Murcia; Spain
| | | | - G. Garcia-Hernandez
- Pediatric Allergy and Pulmonology Units; Pediatrics Department; 12 de Octubre Children's University Hospital; Madrid; Spain
| | - M. M. Suarez-Varela
- Unit of Public Health and Environmental Care; Department of Preventive Medicine; University of Valencia; Research group CIBER CB06/02/0045 CIBER actions-Epidemiology and Public Health; Research Foundation; University Hospital Dr. Peset; Valencia; Spain
| | - D. P. Strachan
- Division of Community Health Sciences; St George's; University of London; London; UK
| | - G. Nagel
- Institute of Epidemiology and Medical Biometry; Ulm University; Ulm; Germany
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Tazesh B, Shaabani A, Fazlollahi MR, Entezari A, Dashti R, Pourpak Z, Moin M. Prevalence of asthma symptoms and smoking behavior among 20 - 44 years old adults in Tehran: A telephone survey. Health (London) 2013. [DOI: 10.4236/health.2013.53064] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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16
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Smit LAM, Kogevinas M, Antó JM, Bouzigon E, González JR, Le Moual N, Kromhout H, Carsin AE, Pin I, Jarvis D, Vermeulen R, Janson C, Heinrich J, Gut I, Lathrop M, Valverde MA, Demenais F, Kauffmann F. Transient receptor potential genes, smoking, occupational exposures and cough in adults. Respir Res 2012; 13:26. [PMID: 22443337 PMCID: PMC3342106 DOI: 10.1186/1465-9921-13-26] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Accepted: 03/23/2012] [Indexed: 11/24/2022] Open
Abstract
Background Transient receptor potential (TRP) vanilloid and ankyrin cation channels are activated by various noxious chemicals and may play an important role in the pathogenesis of cough. The aim was to study the influence of single nucleotide polymorphisms (SNPs) in TRP genes and irritant exposures on cough. Methods Nocturnal, usual, and chronic cough, smoking, and job history were obtained by questionnaire in 844 asthmatic and 2046 non-asthmatic adults from the Epidemiological study on the Genetics and Environment of Asthma (EGEA) and the European Community Respiratory Health Survey (ECRHS). Occupational exposures to vapors, gases, dusts, and/or fumes were assessed by a job-exposure matrix. Fifty-eight tagging SNPs in TRPV1, TRPV4, and TRPA1 were tested under an additive model. Results Statistically significant associations of 6 TRPV1 SNPs with cough symptoms were found in non-asthmatics after correction for multiple comparisons. Results were consistent across the eight countries examined. Haplotype-based association analysis confirmed the single SNP analyses for nocturnal cough (7-SNP haplotype: p-global = 4.8 × 10-6) and usual cough (9-SNP haplotype: p-global = 4.5 × 10-6). Cough symptoms were associated with exposure to irritants such as cigarette smoke and occupational exposures (p < 0.05). Four polymorphisms in TRPV1 further increased the risk of cough symptoms from irritant exposures in asthmatics and non-asthmatics (interaction p < 0.05). Conclusions TRPV1 SNPs were associated with cough among subjects without asthma from two independent studies in eight European countries. TRPV1 SNPs may enhance susceptibility to cough in current smokers and in subjects with a history of workplace exposures.
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Affiliation(s)
- Lidwien A M Smit
- INSERM, CESP Centre for research in Epidemiology and Population Health, U1018, Respiratory and environmental epidemiology Team, Villejuif F-94807, France.
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17
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Fukutomi Y, Taniguchi M, Nakamura H, Konno S, Nishimura M, Kawagishi Y, Okada C, Tanimoto Y, Takahashi K, Akasawa A, Akiyama K. Association between body mass index and asthma among Japanese adults: risk within the normal weight range. Int Arch Allergy Immunol 2011; 157:281-7. [PMID: 22042357 DOI: 10.1159/000327555] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Accepted: 03/14/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Increasing amounts of data have shown that some Asian populations are more susceptible to increased weight and development of noncommunicable disease than Western populations. However, little is known about the association between increased weight, particularly within the normal range, and the development of asthma among Asian populations. METHODS To examine the association between increased body mass index (BMI) and asthma among Japanese adults, data from a nationwide population-based cross-sectional survey of asthma prevalence in Japan were analyzed (n = 22,962; age range 20-79 years). BMIs were classified into 7 categories considering WHO recommendations (cutoff points: 17.00, 18.50, 23.00, 25.00, 27.50 and 30.00), and the association between BMI and the prevalences of asthma as well as asthma symptoms were assessed by multivariate logistic regression. RESULTS The prevalences of obesity (BMI ≥ 30.00) in this population were relatively low (males 3.0%, females 2.3%). BMI categories of 25.00 or higher in both genders were significantly associated with an increased risk of asthma compared with the reference category (BMI 18.50-22.99). Even in females with a BMI of 23.00-24.99, the prevalence of asthma significantly increased (adjusted odds ratio 1.49, 95% confidence interval 1.16-1.92) compared with that in the reference category. CONCLUSIONS An increase in the prevalence of asthma among Japanese females starts at a BMI of 23.00, which was relatively lower than those reported from Western countries. This finding suggests that the Japanese population is likely to have asthma with a lesser degree of obesity than Western populations.
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Affiliation(s)
- Yuma Fukutomi
- Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, Sagamihara, Japan.
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Respiratory Symptoms Were Associated With Lower Spirometry Results During the First Examination of WTC Responders. J Occup Environ Med 2011; 53:49-54. [DOI: 10.1097/jom.0b013e3182028e5c] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Martínez-Sánchez JM, Fernández E, Fu M, Pérez-Ríos M, López MJ, Ariza C, Pascual JA, Schiaffino A, Pérez-Ortuño R, Saltó E, Nebot M. Impact of the Spanish smoking law in smoker hospitality workers. Nicotine Tob Res 2009; 11:1099-106. [PMID: 19640834 DOI: 10.1093/ntr/ntp107] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
INTRODUCTION A smoke-free law went into effect in Spain on 1 January 2006, affecting all enclosed workplaces except hospitality venues, where only partial bans were implemented. The objective was to evaluate the impact of the law among hospitality workers who smoke. METHODS The study design is a before-and-after evaluation. We formed a cohort at baseline, during the 3 months before the law went into effect, with 431 hospitality workers (222 smokers). From them, 288 were successfully followed-up 12 months after the ban (118 were smokers at baseline). We analyzed the quit rate, the reduction in the number of cigarettes smoked per day, changes in the Fagerström Test for Nicotine Dependence (FTND) scores, and changes in salivary cotinine concentrations in smokers from baseline to 1 year after the ban. RESULTS Among 118 smokers, six (5.1%) quit smoking. Among the 112 remaining smokers, the mean number of cigarettes smoked decreased by 8.9% after the ban (from 17.9 to 16.3 cigarettes/day, p < .01). The proportion of workers with a high nicotine dependence (FTND score >6) was reduced by half after the ban (19.5% vs. 9.7%, p = .03). Salivary cotinine decreased by 4.4% after the ban (geometric mean 104.3 vs. 99.7 ng/ml, p = .02). No meaningful differences were found in quit rates and the FTND scores according to type of regulation. DISCUSSION The Spanish smoking law has had beneficial effects (reduction in number of cigarettes smoked, cotinine levels, and FTND score) among hospitality workers who smoke.
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Affiliation(s)
- Jose M Martínez-Sánchez
- Tobacco Research & Control Unit, Institut Català d'Oncologia-IDIBELL, and Department of Clinical Sciences, School of Medicine, Campus of Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
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20
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Fernández E, Fu M, Pascual JA, López MJ, Pérez-Ríos M, Schiaffino A, Martínez-Sánchez JM, Ariza C, Saltó E, Nebot M. Impact of the Spanish smoking law on exposure to second-hand smoke and respiratory health in hospitality workers: a cohort study. PLoS One 2009; 4:e4244. [PMID: 19165321 PMCID: PMC2621339 DOI: 10.1371/journal.pone.0004244] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2008] [Accepted: 12/05/2008] [Indexed: 12/31/2022] Open
Abstract
Background A smoke-free law came into effect in Spain on 1st January 2006, affecting all enclosed workplaces except hospitality venues, whose proprietors can choose among totally a smoke-free policy, a partial restriction with designated smoking areas, or no restriction on smoking on the premises. We aimed to evaluate the impact of the law among hospitality workers by assessing second-hand smoke (SHS) exposure and the frequency of respiratory symptoms before and one year after the ban. Methods and Finding We formed a baseline cohort of 431 hospitality workers in Spain and 45 workers in Portugal and Andorra. Of them, 318 (66.8%) were successfully followed up 12 months after the ban, and 137 nonsmokers were included in this analysis. We obtained self-reported exposure to SHS and the presence of respiratory symptoms, and collected saliva samples for cotinine measurement. Salivary cotinine decreased by 55.6% after the ban among nonsmoker workers in venues where smoking was totally prohibited (from median of 1.6 ng/ml before to 0.5 ng/ml, p<0.01). Cotinine concentration decreased by 27.6% (p = 0.068) among workers in venues with designated smoking areas, and by 10.7% (p = 0.475) among workers in venues where smoking was allowed. In Portugal and Andorra, no differences between cotinine concentration were found before (1.2 ng/ml) and after the ban (1.2 ng/ml). In Spain, reported respiratory symptom declined significantly (by 71.9%; p<0.05) among workers in venues that became smoke-free. After adjustment for potential confounders, salivary cotinine and respiratory symptoms decreased significantly among workers in Spanish hospitality venues where smoking was totally banned. Conclusions Among nonsmoker hospitality workers in bars and restaurants where smoking was allowed, exposure to SHS after the ban remained similar to pre-law levels. The partial restrictions on smoking in Spanish hospitality venues do not sufficiently protect hospitality workers against SHS or its consequences for respiratory health.
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Affiliation(s)
- Esteve Fernández
- Tobacco Research & Control Unit, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain.
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Miller TP, Oswald FL, Reeves MJ. An exploration of factors underlying asthma care and morbidity: a factor analysis of clinical variables. J Allergy Clin Immunol 2008; 122:328-34, 334.e1-5. [PMID: 18572232 DOI: 10.1016/j.jaci.2008.05.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2007] [Revised: 05/14/2008] [Accepted: 05/15/2008] [Indexed: 11/17/2022]
Abstract
BACKGROUND Clinical risk models use recognized risk factors to identify patients at risk for future asthma morbidity. However, the low predictive values of these models suggest an important need to re-evaluate risk assessment strategies. OBJECTIVE To use exploratory factor analysis to define underlying factors operative in asthma treatment and morbidity, and characterize their interrelationships and association with 6-month morbidity. METHODS Children (n = 197) presenting to an emergency department for an acute asthma episode were followed for 6 months (follow-up data available for 84%). Baseline data included demographics, asthma history, current and past symptoms, and current treatment and management. Factor analysis was used to summarize the underlying relationships between variables. Correlations between factors and 6-month morbidity were calculated. RESULTS Factor analysis revealed that 4 factors provided a parsimonious summary of the variables. The factors were labeled current symptom severity, quality of care indicators, previous severe disease, and sociodemographic factors. Positive correlations were observed between quality of care, current symptom severity, and previous severe disease. The factor describing sociodemographic factors was inversely related to current symptom severity and quality of care. Previous severe disease significantly predicted 6-month morbidity. CONCLUSION Quality of care was better in subjects with increased current symptoms or previous severe disease, but poorer in individuals with adverse sociodemographic factors. Previous severe disease was the only factor associated with 6-month morbidity, suggesting that current assessment methods do not adequately account for all underlying factors likely operative in asthma morbidity.
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Affiliation(s)
- Thomas P Miller
- College of Human Medicine, Michigan State University, East Lansing, Mich, USA.
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Pillai SG, Tang Y, van den Oord E, Klotsman M, Barnes K, Carlsen K, Gerritsen J, Lenney W, Silverman M, Sly P, Sundy J, Tsanakas J, von Berg A, Whyte M, Ortega HG, Anderson WH, Helms PJ. Factor analysis in the Genetics of Asthma International Network family study identifies five major quantitative asthma phenotypes. Clin Exp Allergy 2008; 38:421-9. [PMID: 18177490 DOI: 10.1111/j.1365-2222.2007.02918.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Asthma is a clinically heterogeneous disease caused by a complex interaction between genetic susceptibility and diverse environmental factors. In common with other complex diseases the lack of a standardized scheme to evaluate the phenotypic variability poses challenges in identifying the contribution of genes and environments to disease expression. OBJECTIVE To determine the minimum number of sets of features required to characterize subjects with asthma which will be useful in identifying important genetic and environmental contributors. Methods Probands aged 7-35 years with physician diagnosed asthma and symptomatic siblings were identified in 1022 nuclear families from 11 centres in six countries forming the Genetics of Asthma International Network. Factor analysis was used to identify distinct phenotypes from questionnaire, clinical, and laboratory data, including baseline pulmonary function, allergen skin prick test (SPT). RESULTS Five distinct factors were identified:(1) baseline pulmonary function measures [forced expiratory volume in 1 s (FEV(1)) and forced vital capacity (FVC)], (2) specific allergen sensitization by SPT, (3) self-reported allergies, (4) symptoms characteristic of rhinitis and (5) symptoms characteristic of asthma. Replication in symptomatic siblings was consistent with shared genetic and/or environmental effects, and was robust across age groups, gender, and centres. Cronbach's alpha ranged from 0.719 to 0.983 suggesting acceptable internal scale consistencies. Derived scales were correlated with serum IgE, methacholine PC(20), age and asthma severity (interrupted sleep). IgE correlated with all three atopy-related factors, the strongest with the SPT factor whereas severity only correlated with baseline lung function, and with symptoms characteristic of rhinitis and of asthma. CONCLUSION In children and adolescents with established asthma, five distinct sets of correlated patient characteristics appear to represent important aspects of the disease. Factor scores as quantitative traits may be better phenotypes in epidemiological and genetic analyses than those categories derived from the presence or absence of combinations of +ve SPTs and/or elevated IgE.
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Affiliation(s)
- S G Pillai
- Medical Genetics, GlaxoSmithKline, Research Triangle Park, NC, USA
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Kostikas K, Papaioannou AI, Tanou K, Koutsokera A, Papala M, Gourgoulianis KI. Portable exhaled nitric oxide as a screening tool for asthma in young adults during pollen season. Chest 2007; 133:906-13. [PMID: 17951619 DOI: 10.1378/chest.07-1561] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND The fraction of exhaled NO (FeNO) is valuable for the follow-up of asthmatic patients. However, its usefulness as a screening tool for asthma is not established. METHODS We screened a population of 961 university students with a modified European Community Respiratory Health Survey questionnaire that has been previously used for the screening of respiratory symptoms related to asthma. All subjects with a positive answer to at least one question (n = 149) were submitted to FeNO measurement with a portable nitric oxide analyzer. Subsequently, they were submitted to spirometry and evaluated by a physician blinded to FeNO measurements. Seventy students with no respiratory symptoms served as control subjects. RESULTS Asthma was diagnosed in 63 subjects, and allergic rhinitis was diagnosed in 57 subjects. Asthmatics presented higher FeNO values than control subjects (median, 20 parts per billion [ppb]; interquartile range, 14 to 31 ppb; vs median, 11 ppb; interquartile range, 7 to 13 ppb, respectively; p < 0.0001), whereas they did not differ from patients with allergic rhinitis (median, 17 ppb; interquartile range, 12 to 23 ppb; p = 0.28). FeNO values > 19 ppb presented 85.2% specificity and 52.4% sensitivity for the diagnosis of asthma (area under the curve [AUC], 0.723). The diagnostic performance of FeNO was better in nonsmokers (AUC, 0.805), yet FeNO values > 25 ppb were characterized by specificity > 90% for the diagnosis of asthma both in smokers and in nonsmokers. However, FeNO was not a good marker for the differentiation between asthma and allergic rhinitis. CONCLUSIONS FeNO measurement with a portable analyzer is useful for the screening for asthma in young adults. Significant confounding factors are allergic rhinitis and current smoking.
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Affiliation(s)
- Konstantinos Kostikas
- Respiratory Medicine Department, University of Thessaly Medical School, University Hospital of Larissa, Larissa, Greece.
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Vianna EO, García CA, Bettiol H, Barbieri MA, Rona RJ. Asthma definitions, relative validity and impact on known risk factors in young Brazilians. Allergy 2007; 62:1146-51. [PMID: 17845583 DOI: 10.1111/j.1398-9995.2007.01467.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND An asthma score was proposed in the European Community Respiratory Health Survey (ECRHS) framework, as dichotomous definitions could be less appropriate in the study of chronic diseases. The aims of this study were to assess the value of this asthma score in comparison with other definitions of asthma in another population setting, using as criteria bronchial hyperresponsiveness (BHR) to methacholine and diagnosed asthma, and the association of these definitions to known risk factors of asthma. METHODS We used the ECRHS questionnaire on 2063 Brazilians, aged 23-25 years, and measured their BHR. We assessed the positive and negative likelihood ratios (PLR and NLR) of the asthma score (0-8), a three question score (ECRHS definition) and single asthma symptoms in relation to BHR and diagnosed asthma. RESULTS The PLR were relatively low for all asthma definitions with odd ratios varying from 1.47 for asthma score to 5.50 for wheeze and waking with breathlessness without a cold. The NLR were near 1. The PLR were lower for assessments using the score than for dichotomous assessments or the ECRHS definition. The PLR increased with asthma scores, but the prevalence with higher scores was too low for useful analysis. The asthma score was slightly better for identifying associations from a set of known risk factors than the other two approaches. CONCLUSION Our study provided little support for a greater validity of this asthma score over other asthma definitions, and only marginal advantage for identifying risk factors.
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Affiliation(s)
- E O Vianna
- Department of Medicine, Medical School of Ribeirão Preto, University of S. Paulo, Ribeirão Preto, Brazil
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Ribeiro M, Angelini L, Robles-Ribeiro PG, Stelmach R, Santos UDP, Terra-Filho M. Validation of the Brazilian-Portuguese version of the European Community Respiratory Health Survey in asthma patients. J Asthma 2007; 44:371-5. [PMID: 17613632 DOI: 10.1080/02770900701364015] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The European Community Respiratory Health Survey (ECRHS) questionnaire was planned to answer questions about the distribution of asthma. Our objective was to determine the cultural equivalence of the ECRHS into the Brazilian-Portuguese language. METHODS We translated the ECRHS according to international criteria. RESULTS Small cultural adaptations were necessary. Among the 80 participating patients, the Cronbach indices were higher (0.98-1.00) and the Kappa indices varied from 0.77 to 1.00. CONCLUSION The study suggests that the Brazilian version of the ECRHS is conceptually equivalent to the original and similarly reliable and may be used in international studies involving Portuguese-speaking respiratory patients.
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Affiliation(s)
- Marcos Ribeiro
- Occupational and Environmental Group, Pulmonary Division, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
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Al-Mutairi SS, Sharma PN, Al-Alawi A, Al-Deen JS. Impulse oscillometry: an alternative modality to the conventional pulmonary function test to categorise obstructive pulmonary disorders. Clin Exp Med 2007; 7:56-64. [PMID: 17609877 DOI: 10.1007/s10238-007-0126-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2006] [Accepted: 03/21/2007] [Indexed: 10/23/2022]
Abstract
Impulse oscillometry (IOS) was introduced as an alternative modality to the conventional pulmonary function test (cPFT) to test lung mechanics. The objective of this study is to assess the use of IOS as an alternative, or in conjunction with cPFT, to categorise an obstructive respiratory disorder as chronic obstructive pulmonary disease (COPD) or asthma. Patients referred to the PFT laboratory, with different diagnoses of obstructive airways disorders, completed a standardised respiratory questionnaire prior to testing. All recruited subjects completed both modalities of PFT. A total of 146 patients were included. The overall mean age was 51+/-18.4 SD. The majority were non-smokers (68.7%). A standardised diagnosis of asthma was found for 51 subjects, while COPD was diagnosed in 36 subjects and 59 subjects were categorised as normal. The sensitivity of IOS in relation to asthma was 31.3% and 19.6% for cPFT. Among cases of COPD, the cPFT had better sensitivity (47.4%) than IOS (38.95%). The specificity was comparable for IOS and cPFT in relation to asthma and COPD. IOS had better sensitivity (45.8%) in detecting normal subjects than cPFT (28.8%), while specificity was comparable (80.5% and 86.2%, respectively). IOS may replace cPFT where the latter cannot be carried out due to feasibility or lack of cooperation. It can, however, discriminate between diseased and non-diseased subjects.
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Affiliation(s)
- S S Al-Mutairi
- Department of Medicine, Faculty of Medicine, Kuwait University, P.O. Box 24923, Safat 13110, Kuwait.
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Sunyer J, Pekkanen J, Garcia-Esteban R, Svanes C, Künzli N, Janson C, de Marco R, Antó JM, Burney P. Asthma score: predictive ability and risk factors. Allergy 2007; 62:142-8. [PMID: 17298422 DOI: 10.1111/j.1398-9995.2006.01184.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Definition of asthma as a continuous score is a promising tool for population studies that has not yet been fully evaluated. OBJECTIVE We assessed (i) the predictive ability of an asthma score against the occurrence of different asthma-related outcomes and (ii) the risk factors identified when using an asthma score. METHODS The European Community Respiratory Health Study II included subjects from the general population randomly studied during 1991-1993 who were followed up in the years 1998-2001, from 29 centres in 14 countries. A total of 8956 subjects were included. The asthma score consisted of a simple sum of the positive answers to five respiratory symptoms. RESULTS Asthma score at baseline showed a linear relationship with incidence of asthma, the occurrence of asthma attacks, use of asthma medication and bronchial reactivity at the end of the follow-up. Asthma score at the end of follow-up was associated with known risk factors at baseline such as IgE to grass, rhinitis or body mass index, in addition to passive smoking in men [average score ratio (RR) = 1.30; 95% confidence interval (CI) 1.09-1.50] or changes in body mass index (RR = 1.27; 95% CI 1.05-1.27, per each kg/m(2)). CONCLUSION The asthma score had good predictive ability against outcomes related with asthma and also good ability to detect risk factors. This encourages the use of the score as a measure of asthma in epidemiological studies on aetiology of asthma.
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Affiliation(s)
- J Sunyer
- Medical Research Institute (IMIM), Universitat Pompeu Fabra (UPF), Barcelona, Spain
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Grassi M, Bugiani M, de Marco R. Investigating indicators and determinants of asthma in young adults. Eur J Epidemiol 2006; 21:831-42. [PMID: 17119880 DOI: 10.1007/s10654-006-9062-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2006] [Accepted: 08/28/2006] [Indexed: 11/11/2022]
Abstract
BACKGROUND In epidemiological studies on asthma determinants an extreme variability in results exists, probably due to different criteria utilised for defining of an asthma 'case' and for measuring determinants. We aimed to assess multiple indicators and multiple determinants of asthma in young adults by applying latent variable mixture models (LVMMs), a novel statistical modelling with hidden (or latent) variables. METHODS We consider the pooled data of 1103 subjects (aged 20-44 years) from the three Italian centres of the European Community Respiratory Health Survey (ECRHS 1), a standardised database. Underlying multiple asthma indicators (clinicians' diagnosis, self-report symptoms, respiratory trials) both a latent two-class of asthma syndrome, and three continuous latent variables (severity of diagnosed asthma, severity of asthma symptoms, and severity of respiratory function) were investigated. RESULTS Family history was the more relevant predictor of the two-class of asthma syndrome with a risk increase of about 60% per 1 relative with early life events (OR = 1.60, 95% CI: 1.30-1.97). Smoking, active and passive, are predictive for the indicators of severity of asthma symptoms. On average the risk increase of about 10% (OR = 1.10, 95%CI: 1.01-1.20) either per 1 source point of environmental tobacco smoke (ETS) or per 1 packet a day per 10 years. While, the risk of the indicators of both severity of asthma symptoms (OR = 1.59, 95%CI: 1.23-2.06) and severity of respiratory function (OR = 1.37, 95%CI: 1.03-1.82) increase in women compared to men, the risk of the indicators of severity of diagnosed asthma (OR = 0.57, 95%CI: 0.35-0.91) decreases. CONCLUSIONS Considering latent modelling perspective for formulating plausible hypotheses in asthma research, this study highlighted that the host (genetic) component measured as number of relatives with life-events of asthma and/or allergies seems to be the primary determinants of overall observed asthma indicators summarised by hidden two-class of asthma syndrome. Furthermore, a secondary (or trigger) role of smoking on the continuous latent variable of severity of asthma symptoms, and a gender reversal effect were suggested.
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Affiliation(s)
- Mario Grassi
- Department of Health Sciences, Section of Medical Statistics & Epidemiology, University of Pavia, via Bassi, 21, Pavia, 27100, Italy.
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Al-Mutairi S, Al-Awadhi A, Raghupathy R, Al-Khawari H, Sada P, Al-Herz A, Rawoot P. Lupus patients with pulmonary involvement have a pro-inflammatory cytokines profile. Rheumatol Int 2006; 27:621-30. [PMID: 17103171 DOI: 10.1007/s00296-006-0268-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2006] [Accepted: 10/22/2006] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The literature on cytokine response in systemic lupus erythematosus (SLE) is confusing. It is possible that different disease phenotypes have different cytokine profiles. Our aim was to examine the levels of selected pro-inflammatory and anti-inflammatory cytokines in SLE patients with and without pulmonary involvement. METHODS AND SUBJECTS Patients with SLE were interviewed and were subjected to the pulmonary function test and high-resolution computed tomography studies. Serum levels of interleukin (IL)-6, IL-8, IL-10, Il-12, interferon (IFN) gamma, and tumor necrosis factor (TNF) alpha were estimated by enzyme-linked immunosorbent assay. RESULTS Forty-nine of the 61 SLE patients had pulmonary involvement. Median levels of IL-8, IFNgamma, and TNFalpha were significantly higher in the pulmonary group as compared to the non-pulmonary group (p = 0.027, 0.027 and 0.002, respectively). Ratios of pro-inflammatory cytokines to anti-inflammatory cytokines were higher in the pulmonary group as compared to the non-pulmonary group as well as in the pulmonary restrictive subgroup compared to the obstructive subgroup. CONCLUSION Lupus patients with pulmonary involvement have a stronger pro-inflammatory cytokine bias than those without pulmonary involvement.
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Affiliation(s)
- Sana Al-Mutairi
- Department of Medicine, Faculty of Medicine, Kuwait University, PO Box 24923, Safat 13110, Kuwait.
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Eldeirawi KM, Persky VW. Associations of acculturation and country of birth with asthma and wheezing in Mexican American youths. J Asthma 2006; 43:279-86. [PMID: 16809241 DOI: 10.1080/0277090060022869] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Mexican Americans have lower rates of asthma than other ethnic groups in the United States. OBJECTIVE To examine the relationship between country of birth and acculturation with asthma and wheezing among Mexican American youths. METHODS We used Chi-squared statistics and logistic regression analyses to determine the associations of country of birth and acculturation with asthma and wheezing among 1,770 Mexican Americans age 12-19 years who participated in the National Health and Nutrition Examination Survey 1999-2002. RESULTS Mexican American adolescents born in the United States and those with high acculturation levels reported significantly higher prevalence rates of asthma, wheezing, and hay fever than their peers with low acculturation levels and born in Mexico. In multivariate analyses, youths with a high acculturation level had a higher risk of asthma than those with a low acculturation level independent of country of birth. Highly acculturated youths born in the US had a higher risk for wheezing compared with less acculturated US-born or Mexico-born participants after adjusting for confounding variables. In contrast, associations of asthma and wheezing with country of birth were not significant after controlling for acculturation. CONCLUSIONS. Our findings showed that both acculturation and country of birth were linked with the risk of asthma and wheezing, with acculturation having stronger effects than country of birth, among Mexican American youths. These findings may imply that factors modified by immigration and acculturation could influence the risk of asthma and wheezing. Identification of such factors could help in the design of asthma prevention programs.
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Affiliation(s)
- Kamal M Eldeirawi
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, Illinois 60612-7260, USA.
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Radon K, Schulze A, Nowak D. Inverse association between farm animal contact and respiratory allergies in adulthood: protection, underreporting or selection? Allergy 2006; 61:443-6. [PMID: 16512806 DOI: 10.1111/j.1398-9995.2006.00995.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND It has been argued that the inverse association between exposure to farm animals and nasal allergies observed in children and adults might be because of self-selection. AIMS We aimed to assess the health-based selection out of farming in adults. MATERIAL AND METHODS A cross-sectional study was carried out in a rural region. Overall, 4053 inhabitants (63%) aged 18-44 years responded to a questionnaire on respiratory diseases, life-time exposure to farming environments and potential confounders. For 2678 of these, specific immunoglobulin E to common allergens was available. The outcome was: (i) sensitization and symptoms of nasal allergies (symptomatic sensitization); (ii) sensitization without symptoms of nasal allergies (asymptomatic sensitization). RESULTS Farm animal contact in childhood was associated with a decreased risk of symptomatic and asymptomatic sensitization. Continued exposure to farm animals in adulthood further decreased the odds ratio of symptomatic (odds ratio 0.2; 95% confidence interval 0.1, 0.4) but not asymptomatic sensitization (0.7; 0.4, 1.1). Starting farm animal contact in adulthood even increased the odds ratio of asymptomatic sensitization (2.4; 1.1, 5.2). CONCLUSIONS The preventive effect of childhood contact to farm animals against sensitization continues into adulthood. However, in adulthood self-selection based on symptoms and underreporting of symptoms might also play a role.
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Affiliation(s)
- K Radon
- Unit for Occupational and Environmental Epidemiology and Net Teaching, Institute for Occupational and Environmental Medicine, Ludwig-Maximilians-University, Munich, Germany
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Delclos GL, Arif AA, Aday L, Carson A, Lai D, Lusk C, Stock T, Symanski E, Whitehead LW, Benavides FG, Antó JM. Validation of an asthma questionnaire for use in healthcare workers. Occup Environ Med 2006; 63:173-9. [PMID: 16497858 PMCID: PMC2078145 DOI: 10.1136/oem.2005.021634] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Previous studies have described increased occurrence of asthma among healthcare workers, but to our knowledge there are no validated survey questionnaires with which to study this occupational group. AIMS To develop, validate, and refine a new survey instrument on asthma for use in epidemiological studies of healthcare workers. METHODS An initial draft questionnaire, designed by a multidisciplinary team, used previously validated questions where possible; the occupational exposure section was developed by updating health services specific chemical lists through hospital walk-through surveys and review of material safety data sheets. A cross-sectional validation study was conducted in 118 non-smoking subjects, who also underwent bronchial challenge testing, an interview with an industrial hygienist, and measurement of specific IgE antibodies to common aeroallergens. RESULTS The final version consisted of 43 main questions in four sections. Time to completion of the questionnaire ranged from 13 to 25 minutes. Test-retest reliability of asthma and allergy items ranged from 75% to 94%, and internal consistency for these items was excellent (Cronbach's alpha > or = 0.86). Against methacholine challenge, an eight item combination of asthma related symptoms had a sensitivity of 71% and specificity of 70%; against a physician diagnosis of asthma, this same combination showed a sensitivity of 79% and specificity of 98%. Agreement between self-reported exposures and industrial hygienist review was similar to previous studies and only moderate, indicating the need to incorporate more reliable methods of exposure assessment. Against the aerollergen panel, the best combinations of sensitivity and specificity were obtained for a history of allergies to dust, dust mite, and animals. CONCLUSIONS Initial evaluation of this new questionnaire indicates good validity and reliability, and further field testing and cross-validation in a larger healthcare worker population is in progress. The need for development of more reliable occupational exposure assessment methods that go beyond self-report is underscored.
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Affiliation(s)
- G L Delclos
- The University of Texas School of Public Health, Houston, Texas 77030, USA.
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Wjst M, Dharmage S, André E, Norback D, Raherison C, Villani S, Manfreda J, Sunyer J, Jarvis D, Burney P, Svanes C. Latitude, birth date, and allergy. PLoS Med 2005; 2:e294. [PMID: 16190778 PMCID: PMC1240049 DOI: 10.1371/journal.pmed.0020294] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2005] [Accepted: 07/25/2005] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The space and time distribution of risk factors for allergic diseases may provide insights into disease mechanisms. Allergy is believed to vary by month of birth, but multinational studies taking into account latitude have not been conducted. METHODS AND FINDINGS A questionnaire was distributed in 54 centres to a representative sample of 20- to 44-y-old men and women mainly in Europe but also including regions in North Africa, India, North America, Australia, and New Zealand. Data from 200,682 participants were analyzed. The median prevalence of allergic rhinitis was 22%, with a substantial variation across centres. Overall, allergic rhinitis decreased with geographical latitude, but there were many exceptions. No increase in prevalence during certain winters could be observed. Also, no altered risk by birth month was found, except borderline reduced risks in September and October. Effect estimates obtained by a multivariate analysis of total and specific IgE values in 18,085 individuals also excluded major birth month effects and confirmed the independent effect of language grouping. CONCLUSION Neither time point of first exposure to certain allergens nor early infections during winter months seems to be a major factor for adult allergy. Although there might be effects of climate or environmental UV exposure by latitude, influences within language groups seem to be more important, reflecting so far unknown genetic or cultural risk factors.
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Affiliation(s)
- Matthias Wjst
- Gruppe Molekulare Epidemiologie, Institut für Epidemiologie, Forschungszentrum für Umwelt und Gesundheit, Munich, Germany.
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Ulrik CS, von Linstow ML, Nepper-Christensen S, Porsbjerg C, Backer V. Chronic mucus hypersecretion: a marker of asthma in young adults? Respir Med 2005; 99:1576-82. [PMID: 16291078 DOI: 10.1016/j.rmed.2005.03.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2004] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate if chronic mucus hypersecretion (CMH) can be used as a marker of asthma in young adults. STUDY DESIGN AND SETTING Cross-sectional study of a population sample of young Danish adults (n=624, 279 males), aged 19-29 years. Case history, including tobacco exposure and respiratory symptoms, was obtained by questionnaire. Pulmonary function, histamine responsiveness, bronchodilator reversibility, skin test reactivity, and leukocyte count were measured using standard techniques. RESULTS The overall prevalence of CMH was 7.7%, 8.4% in females and 6.9% in males, respectively, of whom more than 70% were current smokers. The presence of CMH was significantly associated with self-reported asthma, dyspnea at exertion, number of pack-years, lower FEV1/FVC ratio, and lower BMI. However, no significant association was found between CMH and the following asthma-related factors: airway responsiveness to inhaled histamine, bronchodilator reversibility, self-reported rhinitis or eczema, atopy, FEV1 (%pred), and B-eosinophil count. CONCLUSIONS CMH is a common finding in young adults, primarily in smokers. CMH was related to respiratory symptoms suggesting asthma, but no significant association was observed between CMH and objective signs of asthmatic airway lability. The present findings therefore may suggest that CMH is likely to be an early marker of smoking-related lung disease in young adults, instead of a marker of reversible obstructive lung disease, which may have important implications for the approach to young people presenting with respiratory symptoms suggesting asthma.
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Salo MS PM, MD JX, PhD CAJ, MD YL, Avol PhD EL, MD JG, London MD SJ. Indoor allergens, asthma, and asthma-related symptoms among adolescents in Wuhan, China. Ann Epidemiol 2005; 14:543-50. [PMID: 15350953 PMCID: PMC1626161 DOI: 10.1016/j.annepidem.2003.09.015] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2003] [Accepted: 09/29/2003] [Indexed: 12/14/2022]
Abstract
PURPOSE Information on indoor allergen exposures among non-Western populations, which have lower prevalence of atopic illness, is scant. We examined whether exposures to common indoor allergens were associated with doctor-diagnosed asthma and asthma-related symptoms among Chinese adolescents. METHODS A cross-sectional study of 4,185 ninth grade students was conducted at 22 randomly selected schools in Wuhan, China. Information on respiratory health and exposures to indoor allergens was obtained by a self-administered questionnaire completed in class. RESULTS Having animals currently was associated with persistent cough [prevalence odds ratio (POR)=1.54, 95% confidence interval (CI ): 1.21-2.11] and wheeze (POR=1.41, 95% CI: 1.03-1.94). Early-life exposure to animals was also associated with doctor-diagnosed asthma (POR=1.95, 95% CI: 1.35-2.82). Associations with respiratory symptoms strengthened with higher levels of exposure and for exposure in both early childhood and in adolescence. Exposure to cockroaches and having mold/water damage in the home contributed especially to wheezing (POR=2.03, 95% CI: 1.41-2.90 for cockroaches; POR=2.49, 95% CI: 1.82-3.40 for mold/water damage). CONCLUSIONS Indoor allergen exposures were positively associated with asthma diagnosis and persistent respiratory symptoms among Chinese adolescents. Neither early-life nor current exposure to animals was protective for asthma or asthma-related symptoms.
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Affiliation(s)
- Päivi M. Salo MS
- National Institute of Environmental Health Sciences, Epidemiology Branch, Natl Inst Health, Dept of Health and Human Services, Research Triangle Park, NC, USA
| | - Jiang Xia MD
- Wuhan Public Health and Anti-Epidemic Station, Wuhan, Hubei Province, China
| | | | - Yan Li MD
- Wuhan Health Bureau, Wuhan, Hubei Province, China
| | - Edward L. Avol PhD
- Department of Preventive Medicine, USC Keck School of Medicine, Los Angeles, CA, USA
| | - Jie Gong MD
- Wuhan Public Health and Anti-Epidemic Station, Wuhan, Hubei Province, China
| | - Stephanie J. London MD
- National Institute of Environmental Health Sciences, Epidemiology Branch, Natl Inst Health, Dept of Health and Human Services, Research Triangle Park, NC, USA
- Correspondence to: Dr. Stephanie London , National Institute of Environmental Health Sciences, Epidemiology Branch, MD A3-05, PO Box 12233, Research Triangle Park, NC 27709, USA, Telephone: +1 (919) 541-5772 Fax: +1 (919) 541-2511
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Salo PM, Xia J, Johnson CA, Li Y, Kissling GE, Avol EL, Liu C, London SJ. Respiratory symptoms in relation to residential coal burning and environmental tobacco smoke among early adolescents in Wuhan, China: a cross-sectional study. Environ Health 2004; 3:14. [PMID: 15585063 PMCID: PMC543575 DOI: 10.1186/1476-069x-3-14] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2004] [Accepted: 12/07/2004] [Indexed: 05/24/2023]
Abstract
BACKGROUND Cigarette smoking and coal burning are the primary sources of indoor air pollution in Chinese households. However, effects of these exposures on Chinese children's respiratory health are not well characterized. METHODS Seventh grade students (N = 5051) from 22 randomly selected schools in the greater metropolitan area of Wuhan, China, completed an in-class self-administered questionnaire on their respiratory health and home environment. RESULTS Coal burning for cooking and/or heating increased odds of wheezing with colds [odds ratio (OR) = 1.57, 95% confidence interval (CI): 1.07-2.29] and without colds (OR = 1.44, 95% CI: 1.05-1.97). For smoking in the home, the strongest associations were seen for cough (OR = 1.74, 95% CI: 1.17-2.60) and phlegm production (OR = 2.25, 95% CI: 1.36-3.72) without colds among children who lived with two or more smokers. CONCLUSIONS Chinese children living with smokers or in coal-burning homes are at increased risk for respiratory impairment. While economic development in China may decrease coal burning by providing cleaner fuels for household energy use, the increasing prevalence of cigarette smoking is a growing public health concern due to its effects on children. Adverse effects of tobacco smoke exposure were seen despite the low rates of maternal smoking (3.6%) in this population.
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Affiliation(s)
- Päivi M Salo
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, MD A3-05, PO Box 12233, Research Triangle Park, NC 27709, USA
| | - Jiang Xia
- Wuhan Public Health and Anti-Epidemic Station, No. 24 N. Jianghan Road, Wuhan, Hubei 430022, China
| | - C Anderson Johnson
- Institute for Health Promotion & Disease Prevention Research, USC Keck School of Medicine, 1000 South Fremont Ave., Unit 8, Alhambra, CA 91803, USA
| | - Yan Li
- Wuhan Health Bureau, 2 YiYuan Road, Wuhan, Hubei 430014, China
| | - Grace E Kissling
- Biostatistics Branch, National Institute of Environmental Health Sciences, National Institutes of Health, MD A3-03, PO Box 12233, Research Triangle Park, NC 27709, USA
| | - Edward L Avol
- Department of Occupational & Environmental Health, USC Keck School of Medicine, CHP 236, 1540 Alcazar St., Los Angeles, CA 90089, USA
| | - Chunhong Liu
- Wuhan Public Health and Anti-Epidemic Station, No. 24 N. Jianghan Road, Wuhan, Hubei 430022, China
| | - Stephanie J London
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, MD A3-05, PO Box 12233, Research Triangle Park, NC 27709, USA
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Sunyer J, Basagaña X, Roca J, Urrutia I, Jaen A, Antó JM, Burney P. Relations between respiratory symptoms and spirometric values in young adults: the European community respiratory health study. Respir Med 2004; 98:1025-33. [PMID: 15481280 DOI: 10.1016/j.rmed.2004.01.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We aim to assess whether respiratory symptoms are associated with lung function in young adults, and whether any such relation is similar in those with asthma, in men and women, and in different countries. Study participants (aged 20-44 years) were randomly selected from the general population in 35 centres in 15 countries as part of the European Community Respiratory Health Study. In all, 12,541 subjects (47%) completed a respiratory symptoms questionnaire and spirometry, metacholine challenge and immunoglobulin E tests. Indicators of diagnosed asthma showed the largest association with airways obstruction (FEV1--maximal 1-s forced expiratory volume/forced vital capacity--FVC < 70%), followed by symptoms of wheezing or shortness of breath, in both genders. Among the 96% of subjects whose FEV1/FVC ratios were greater or equal to 70%, wheezing or shortness of breath was associated with lower FEV1 levels (-211 ml in men and -169 ml in women (P < 0.01)), independent of diagnosed asthma, smoking, atopy or bronchial responsiveness. This association was not explained by a lower FVC. Symptoms of chronic bronchial mucus hypersecretion (chronic phlegm) were unrelated to both airways obstruction and FEV1 levels. Findings were homogeneous across all centres. These results suggest that lung diseases that cause wheezing are generally associated with impaired lung function.
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Affiliation(s)
- Jordi Sunyer
- Institut Municipal Investigació Medica, Doctor Aiguader 80, Unitat de Recerca Respiratòria i Ambiental, 08003 Barcelona, Catalonia, Spain.
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Holguin F, Mannino DM, Antó J, Mott J, Ford ES, Teague WG, Redd SC, Romieu I. Country of birth as a risk factor for asthma among Mexican Americans. Am J Respir Crit Care Med 2004; 171:103-8. [PMID: 15516539 DOI: 10.1164/rccm.200402-143oc] [Citation(s) in RCA: 105] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In the United States, among Hispanics, Mexican Americans have the lowest rate of asthma. However, this population includes Mexican Americans born in the United States and in Mexico, and risk factors that might impact the prevalence of asthma differ between these groups. To determine the prevalence of and risk factors for asthma among U.S.- and Mexican-born Mexican Americans, we analyzed data from two U.S. surveys that included 4,574 persons who self-reported their ethnicity as Mexican American from the Third National Health and Nutrition Examination Survey (NHANES III) 1998-1994 and 12,980 persons who self-reported their ethnicity as Mexican American from National Health Interview Survey (NHIS) 1997-2001. U.S.-born Mexican Americans were more likely than Mexican-born Mexican Americans to report ever having asthma in both the NHANES III (7% [SE 0.5] vs. 3% [SE 0.3], p < 0.001) and NHIS surveys (8.1% [0.4] vs. 2.5% [0.2], p < 0.001). In a multivariate regression model controlling for multiple demographic variables and health care, the risk for asthma was higher among U.S.-born Mexicans in NHANES III (odds ratio 2.1, 95% confidence interval 1.4-3.3) and NHIS (odds ratio 2.7, 95% confidence interval 1.6-5.5). In conclusion, the prevalence of asthma was higher in U.S.-born than in Mexican-born Mexican Americans. This finding highlights the importance of environmental exposures in developing asthma in a migratory population.
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Affiliation(s)
- Fernando Holguin
- Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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Radon K, Ehrenstein V, Praml G, Nowak D. Childhood visits to animal buildings and atopic diseases in adulthood: an age-dependent relationship. Am J Ind Med 2004; 46:349-56. [PMID: 15376228 DOI: 10.1002/ajim.20000] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Several studies reported protective effects of farming environments against atopic diseases. Therefore, we aimed to establish the relevant timing of exposure in early life. METHODS A cross-sectional study was carried out in a rural town. Overall, 4,537 inhabitants aged 18-44 years were eligible. Of these, 3,112 (69%) responded to a postal questionnaire on atopic diseases, life-time exposure to farming environments, and potential confounders. RESULTS Those with regular childhood exposure to animal buildings had a significantly reduced risk of nasal allergies. The greatest reduction in risk was seen for respondents starting regular visits to animal stables during the 1st year of life or between ages 3 and 5. Participants reporting start of exposure after age 5 remained at a lower risk for nasal allergies (0.70, 0.49-1.01). CONCLUSIONS The preventive effect of animal buildings' exposure against atopic respiratory diseases continues into adulthood. The magnitude of the effect appears to be age-dependent.
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Affiliation(s)
- Katja Radon
- Institute for Occupational and Environmental Medicine, Unit for Occupational and Environmental Epidemiology & Net Teaching, Ludwig-Maximilians-University, Munich, Germany.
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Vasconcelos M, Accioly L, Leão M, Lima D, Aguiar Filho A, Lopes Neto E, Sarinho E, Wirtsbiki P. Conceitos de asma e instrumentos de levantamentos epidemiológicos de prevalência. REVISTA PORTUGUESA DE PNEUMOLOGIA 2004. [DOI: 10.1016/s0873-2159(15)30582-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Buffels J, Degryse J, Heyrman J, Decramer M. Office Spirometry Significantly Improves Early Detection of COPD in General Practice. Chest 2004; 125:1394-9. [PMID: 15078751 DOI: 10.1378/chest.125.4.1394] [Citation(s) in RCA: 152] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES To determine if spirometry is essential for the early detection of COPD in general practice, compared to the screening value of a short questionnaire. METHODS A prospective survey of the population aged 35 to 70 years visiting their general practitioner (GP) during a 12-week period, using a questionnaire on symptoms of obstructive lung disease (OLD). Spirometry was performed in all participants with positive answers and in a 10% random sample from the group without complaints. Twenty GPs were provided with a hand-held spirometer, and received training in performance and interpretation of lung function tests. All 35- to 70-year-old patients (n = 3,408) were screened for current use of bronchodilators. The subgroup receiving bronchodilators (n = 250, 7%) was assumed to have OLD, and was excluded. Airflow obstruction was defined according to the European Respiratory Society standards. RESULTS The positive predictive power of the questionnaire was low (sensitivity, 58%; specificity, 78%; likelihood ratio, 2.6). One hundred twenty-six cases of formerly unknown OLD were detected in the group of patients with complaints, vs an extrapolated number of 90 in the group without complaints. Despite a negative predictive value of 95% for the questionnaire used, 42% of the newly diagnosed cases of OLD would not have been detected without spirometry. CONCLUSIONS The use of a spirometer is mandatory if early stages of OLD are to be detected in general practice. Screening for airflow obstruction almost doubles the number of known patients with OLD.
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Affiliation(s)
- Johan Buffels
- Department of General Practice, Katholieke Universiteit, Leuven, Belgium.
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Gislason T, Janson C, Vermeire P, Plaschke P, Björnsson E, Gislason D, Boman G. Respiratory symptoms and nocturnal gastroesophageal reflux: a population-based study of young adults in three European countries. Chest 2002; 121:158-63. [PMID: 11796445 DOI: 10.1378/chest.121.1.158] [Citation(s) in RCA: 154] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVE To estimate the possible association between reported symptoms of gastroesophageal reflux (GER) after bedtime, sleep-disordered breathing, respiratory symptoms, and asthma. DESIGN Cross-sectional international population survey. PARTICIPANTS Participants consisted of 2,661 subjects (age range, 20 to 48 years) from three countries (Iceland, Belgium, and Sweden), of whom 2,202 were randomly selected from the general population and 459 were added because of reported asthma. MEASUREMENTS The investigation included a structured interview, spirometry, methacholine challenge, peak flow diary, skin-prick tests, and a questionnaire on sleep disturbances. RESULTS In the random population sample, 101 subjects (4.6%) reported GER, which was defined as the occurrence of heartburn or belching after going to bed at least once per week. Subjects with nocturnal GER more often were overweight and had symptoms of sleep-disordered breathing than participants not reporting GER. Participants with GER were more likely to report wheezing (adjusted odds ratio [OR], 2.5), breathlessness at rest (adjusted OR, 2.8), and nocturnal breathlessness (adjusted OR, 2.9), and they had increased peak flow variability compared to the subjects without GER. Physician-diagnosed current asthma was reported by 9% of subjects with GER compared to 4% of those not reporting GER (p < 0.05). Subjects with the combination of asthma and GER had a higher prevalence of nocturnal cough, morning phlegm, sleep-related symptoms, and higher peak flow variability than subjects with asthma alone. CONCLUSION The occurrence of GER after bedtime is strongly associated with both asthma and respiratory symptoms, as well as symptoms of obstructive sleep apnea syndrome. The partial narrowing or occlusion of the upper airway during sleep, followed by an increase in intrathoracic pressure, might predispose the patient to nocturnal GER and, consequently, to respiratory symptoms.
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Tobin MJ. Sleep-disordered breathing, control of breathing, respiratory muscles, pulmonary function testing, nitric oxide, and bronchoscopy in AJRCCM 2000. Am J Respir Crit Care Med 2001; 164:1362-75. [PMID: 11704580 DOI: 10.1164/ajrccm.164.8.2108124] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- M J Tobin
- Division of Pulmonary and Critical Care Medicine, Loyola University of Chicago Stritch School of Medicine and Hines Veterans Affairs Hospital, Hines, Illinois 60141, USA.
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Janson C, Anto J, Burney P, Chinn S, de Marco R, Heinrich J, Jarvis D, Kuenzli N, Leynaert B, Luczynska C, Neukirch F, Svanes C, Sunyer J, Wjst M. The European Community Respiratory Health Survey: what are the main results so far? European Community Respiratory Health Survey II. Eur Respir J 2001; 18:598-611. [PMID: 11589359 DOI: 10.1183/09031936.01.00205801] [Citation(s) in RCA: 296] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The European Community Respiratory Health Survey (ECRHS) was the first study to assess the geographical variation in asthma and allergy in adults using the same instruments and definitions. The database of the ECRHS includes information from approximately 140,000 individuals from 22 countries. The aim of this review is to summarize the results of the ECRHS to date. The ECRHS has shown that there are large geographical differences in the prevalence of asthma, atopy and bronchial responsiveness, with high prevalence rates in English speaking countries and low prevalence rates in the Mediterranean region and Eastern Europe. Analyses of risk factors have highlighted the importance of occupational exposure for asthma in adulthood. The association between sensitization to individual allergens and bronchial responsiveness was strongest for indoor allergens (mite and cat). Analysis of treatment practices has confirmed that the treatment of asthma varies widely between countries and that asthma is often undertreated. In conclusion, the European Community Respiratory Health Survey has shown that the prevalence of asthma varies widely. The fact that the geographical pattern is consistent with the distribution of atopy and bronchial responsiveness supports the conclusion that the geographical variations in the prevalence of asthma are true and most likely due to environmental factors.
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Affiliation(s)
- C Janson
- Dept of Medical Science: Respiratory Medicine and Allergology, Uppsala University, Sweden
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Golshan M, Barahimi H, Nasirian K. Prevalence of chronic bronchitis and chronic respiratory symptoms in adults over the age of 35 years in Isfahan, Iran in 1998. Respirology 2001; 6:231-5. [PMID: 11555382 DOI: 10.1046/j.1440-1843.2001.00331.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Chronic obstructive airways disease (COPD) in older patients is reported to be not only common, but also frequently overlooked and untreated by general practitioners. Chronic bronchitis is one of the major components of COPD and can be readily screened. This study investigates the prevalence of chronic bronchitis and related symptoms in Iran with special reference to COPD. METHODOLOGY A random sample of 4636 participants aged 35 years and over, attended a research clinic for interview and physical examinations. Those reporting classic symptoms of chronic bronchitis were referred to a pulmonary clinic for pulmonary function testing. RESULTS Two hundred and sixteen patients (4.65%) had chronic bronchitis. Among these, 78 (36.1%) had obstructive airways disease. Decreased forced expiratory volume in 1 s/forced vital capacity to levels of less than 70% were recorded in 45 patients (42.9% of the tested population). Less than 25% of the patients had a previous diagnosis of chronic bronchitis and/or airways disease. CONCLUSION Obstructive airway diseases are under-diagnosed in developing countries. Physicians practising in such areas of the world should be aware, and try to detect the subclinical illnesses, especially in urban areas.
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Affiliation(s)
- M Golshan
- Division of Pulmonary Medicine, St. Zahra Medical Center, Isfahan University of Medical Sciences, Isfahan, Iran.
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